The UN and Harm Reduction - Revisited

An unauthorised report on the outcomes of the 48th CND session

The US pressure on the UNODC to withdraw support from needle exchange and other harm reduction approaches backfired at the 48th session of the CND in March 2005. Delegates from around the globe stood up to defend the overwhelming evidence that harm reduction measures are effective against the spread of HIV/AIDS. In this briefing TNI analyses the proceedings and results of the CND meeting in Vienna in March 2005, and outlines several options for follow-up and recommends next steps to take.

The US pressure on the UN Office on Drugs and Crime (UNODC) to withdraw support from needle exchange and other harm reduction approaches backfired at the 48th session of the UN Commission on Narcotic Drugs (CND) from 7-11 March in Vienna. During the thematic debate on the issue delegates from around the globe stood up to defend the overwhelming evidence that harm reduction measures are effective against the spread of HIV/AIDS.

Just prior to the CND, over 334 NGOs and many individuals from 56 countries made an urgent appeal to delegates in an open letter: "As you gather this year to debate HIV/AIDS prevention and drug abuse, we respectfully urge you to support syringe exchange, opiate substitution treatment and other harm reduction approaches demonstrated to reduce HIV risk; to affirm the human rights of drug users to health and health services; and to reject efforts to overrule science and tie the hands of those working on the front lines. No less than the future of the HIV epidemic is at stake."

Leading newspapers devoted editorials to the issues at stake. Taken together, the NGO mobilisation around this CND was remarkable and quite unprecedented, and it had a major impact. The US was clearly uncomfortable with it all and at the most tense point in the negotiations had NGO observers removed from the meeting. After protests, the CND secretariat allowed NGOs access to the Committee of the Whole again, clarifying that only informal drafting committees can be closed off to NGOs at the request of governments.

In a marked shift from previous years, the European Union presented a common position on this issue, and Latin American, African and Asian countries almost unanimously showed support for harm reduction programmes. One after the other explained that they implement needle exchange and substitution treatment projects, convinced by the available evidence and lessons learned from other countries that a humane and pragmatic response to injecting drug use - as a major triggering factor in the HIV/AIDS crisis in many countries - is the only effective way to reverse the epidemic.

The US delegation in Vienna stood virtually alone in its anti-harm reduction campaign. Japan was the only country seconding the US fully in its 'bullying flat-earthism' as the Washington Post called it in an editorial a few days before the start of the CND meeting. On particular moments during the tense negotiations, unfortunately, Russia and Malaysia also sided with the zero tolerance ideology. The US and Japan rank high among the major donors that keep UNODC running. Moreover, CND resolutions are agreed by consensus, so even a small minority can block any progress, which they effectively did on the HIV/AIDS issue.

In terms of formal outcomes the results are most disappointing therefore, perhaps a step backwards regarding the ambiguity surrounding the mandate for UNODC to collaborate in harm reduction efforts. Still, the session marked an important moment in global drug policy making, demonstrating that the rising tide in support of harm reduction has crossed its point of no return.

TNI's recommendations

Harm reduction deserves its place in the CND, UNODC, the INCB and the UN Conventions. It is time to recognise the paradigm shift of the past decade, the gradual erosion of zero-tolerance ideology.

The US must acknowledge the evidence that needle exchange is an effective policy intervention, "it should at least allow the rest of the world to get on with saving millions of lives" which requires a clear mandate for the UNODC to support harm reduction projects where countries request the agency to do so.

Harm reduction-friendly nations should consider increasing funding to UNODC to diminish the agency's vulnerability to US donor pressure.

The functioning of the CND and the governing structure of UNODC should be reviewed within the broader context of UN reform.

For the sake of UN consistency, UNODC's paralysed mandate in the field of harm reduction and HIV prevention should be discussed by UNAIDS and the higher UN echelons (ECOSOC, GA, SG).

Better co-ordination among the expanding group of harm reduction-friendly countries within the EU and cross-regionally could enable breakthroughs at the next CND and in 2008.

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